Incidence and pattern of mandibular fractures in rural population: a review of 324 patients at a tertiary hospital in Loni, Maharashtra, India

Patterns and Trends of Facial Fractures at a Tertiary Care Trauma Center in India - A 13 years Retrospective Study

Study Design

Retrospective study.

Objective

The purpose of this study was to retrospectively analyze the prevalence, pattern, diagnosis, and treatment of the facial fractures falling under ambit of facial plastic surgery in a multi-specialty hospital at India from the year 2006-2019.

Methods

This retrospective study analyzed 1508 patients, having orbital fractures (from 2006 to 2019) for demographic data, cause of trauma, type of fracture, and the treatment given. The data were compiled in excel and analyzed by using SPSS version 21.0.

Results

Out of these 1508 patient (1127 (74.73%)-males and 381 (25.27%)-females), the etiology of injuries was Road traffic accident (RTA) (49.20%), assault (26.52%), and sports injuries (11.47%). The most common fracture pattern was Isolated Orbit and/or Orbital Floor fracture in 451 patients (32.08%), followed by Mid-facial fractures (21.93%). Also, 105 patients (6.96%) experienced ocular/retinal trauma along with other fractures.

Conclusions

Orbit, peri-ocular, and mid-face trauma comprised a large position of this study. It requires a great deal of expertise to treat such complex trauma, which is not covered in one specialty alone. Hence, a holistic approach of craniofacial fracture management, rather than limiting these skills to water-tight craniofacial compartments becomes necessary. The study highlights the critical need of multidisciplinary approach for predictable and successful management of such complex cases.

Trends in mandibular fracture patterns in central Telangana - A retrospective overview and analysis

BACKGROUND/AIM

Socio-economic, environmental and cultural influences may lead to discrepancies in the distribution and occurrence of orofacial injuries. The aim of this study was to analyze the patient demographics and current patterns of mandibular fractures within a geographic population.

MATERIAL AND METHODS

The medical records of patients with facial trauma treated over a period of 3 years were retrieved and reviewed. Their data were analyzed based on the following parameters-age, gender, mechanism of trauma, seasonal variation, drug/alcohol abuse at the time of trauma, number, and anatomic location of fractures.

RESULTS

Of all the patients with maxillofacial injuries, 56% had mandibular fractures and 80% of these were sustained in road traffic accidents. Nearly 44% of patients had multiple mandibular fractures giving an average of about 1.6 fractures per mandible. Alcohol abuse was seen in 39% of patients. Seasonal influence indicated that the monsoon season had the highest incidence of trauma.

CONCLUSION

Fracture patterns vary according to the etiology of the fracture and direction of the impact force. This information can help in the diagnosis and as a guide to future funding of preventive public health programs.

A review of forensic analysis of dental and maxillofacial skeletal trauma

Dental and maxillofacial trauma analysis in the forensic context, includes assessment of both living and deceased persons. It is required in all cases where human abuse is suspected and where signs of skeletal trauma are detected in human remains. Skeletal trauma refers to the damage inflicted to bone, teeth and other hard tissues. An accurate analysis of the dental and maxillofacial trauma is achieved by the assessment of the remains by forensic pathologists, anthropologists and odontologists. This paper aims to review dental and maxillofacial skeletal trauma in the scope of forensic science. High-velocity projectile, sharp force, blunt force, and thermal trauma showing different traits in maxillofacial structures are discussed. Regarding non-fatal physical abuse, head and neck are the most frequently injured areas, resulting in fractures, contusions, burns and traumatic dental injuries.

Maxillofacial Prosthesis in Dentofacial Traumas: A Retrospective Clinical Study and Introduction of New Classification Method

Background. Maxillofacial trauma represents a field of common interest as regards both the maxillofacial surgery and prosthodontics, especially for the functional and aesthetic stomatognathic rehabilitation. This condition necessitates relationship between maxillofacial surgeon and prosthodontist, to achieve the ultimate treatment goal. Purpose. The purpose of this study is to make predictable patients outcomes classifying their clinical data, using certain parameters and introducing a new classification method. Materials and Methods. We have chosen 7 parameters to classify the entity of the damage of these patients and to make their treatment and their prognosis predictable: number of teeth lost (T1–T4), upper/lower maxilla (U/L), alveolar/basal bone (Alv/B), gingival tissues (G), soft tissues (S), adult/child (a/c), and reconstructed patient (R). Results and Conclusions. The multidisciplinary approach and the collaboration between multiple clinical figures are therefore critical for the success of the treatment of these patients. The presence and quantification of above parameters influence the treatment protocol; patients undergo different levels of treatment depending on the measured data. The recognition of certain clinical parameters is fundamental to frame diagnosis and successful treatment planning.

Patterns of Maxillofacial Fractures in Uttar Pradesh, India

This study aimed to obtain dependable epidemiologic data of the variation in cause and characteristics of maxillofacial fractures by identifying, describing, and quantifying trauma. This retrospective study was conducted in the state of Uttar Pradesh, India, over 1 year, based on a systematic computer-assisted database search from March 2015 to March 2016 for maxillofacial fractures. The demographics, etiology, geographic distribution, date of injury, site and number of fractures, and type of intervention were recorded for each. The study population consisted of 1,000 patients with 1,543 fractures. The male:female ratio was 8:1. A peak incidence of fractures was seen in the third decade (mean age: 30.3) with maximum patients younger than 40 years (80.8%). The incidence of fractures was highest in spring (42.9%). Road traffic accidents were the most common cause of trauma (64.4%) and mainly involved two wheelers (60.2%). Single-site fractures were most common. Mostly zygomatic (45.1%) and mandibular fractures (44.4%) were encountered, accounting for approximately 90% of all fractures. The main site of mandibular fractures was the body (34.4%); 46.2% of fractures underwent open reduction and internal fixation (ORIF) while 53.8% were treated by closed methods. The study provides important data to contrive future plans for injury prevention. The trend of most traffic-related injuries continues with the increasing traffic on roads. Zygomatic complex and mandibular fractures remain the most frequent. The major populations at risk are young men and those driving two wheelers. The use of helmets could achieve a large reduction in maxillofacial fractures. Awareness for preventive measures and safety guidelines should be propagated and legislation on traffic rules strictly reinforced.

Clinical Features and Treatment Modes of Mandibular Fracture at the Department of Oral and Maxillofacial Surgery, Shimane University Hospital, Japan

Background

The number of elderly patients with maxillofacial trauma is rapidly increasing due to active lifestyles and longevity. Shimane prefecture has the fastest growing proportion of elderly individuals in Japan. The aim of this study was to reveal the distinctive features and treatment modes of mandibular fracture treatment mode in patients requiring hospitalization at the Department of Oral and Maxillofacial Surgery, Shimane University Hospital, Japan.

Patients and Methods

Patient age, sex, period between injury and first consultation, years since injury, cause of injury, fracture site, treatment, and duration of hospitalization were evaluated. Univariate Poisson regression, relative risk with 95% confidence interval based on the Wald test, Fisher’s exact test, and Kruskal-Wallis test were used to explore associations among clinical and demographic variables.

Results

In total, 305 patients were diagnosed with and hospitalized for mandibular fracture from 1980 to 2010. Younger age increased the risk for mandibular fracture. Incidence was higher in males than females, particularly in the young, but the male to female ratio decreased with age. The period until first hospital consultation decreased progressively over the study period. Fall was a much more frequent cause in patients aged ≥60 than in those aged <60 years. Mandibular fracture with condyle, symphysis, and angle involvement were most common and were associated with sex, age, and treatment mode. Length of hospitalization has decreased since 1980.

Conclusion

In our department, patients aged ≥60 years accounted for a greater proportion of mandibular fracture cases than in many previous studies, reflecting the greater proportion of elderly residents in Shimane prefecture.

Prevalence and pattern of mandibular fracture in Central India

INTRODUCTION

The etiology and pattern of mandibular fracture vary considerably among different study populations. Despite many reports about the incidence, diagnosis and treatment of mandibular fracture there is limited knowledge about the specific type or pattern of mandibular fractures in South Asian countries. This study attempts to delineate predictable patterns of fracture based on patient demographics and mechanism of injury in central part of India.

MATERIALS AND METHODS

The medical records of patients with mandibular fractures treated over a 3 years period were identified and analyzed based on age, sex, mechanism of trauma, seasonal variation, drug/alcohol abuse, number and anatomic location.

RESULTS

We reviewed 464 patients having mandibular fractures with age ranging from 7 to 89 years. Male (343, 79%) to female (91, 21%) ratio was 3.7:1, significantly higher for males. The highest incidence (37.5%) of mandibular fractures was in the age group of 21-30 years. The main cause was road traffic accidents (RTAs, 68.8%) followed by falls (16.8%), assaults (11%) and other reasons (3.8%). Parasymphyseal fractures were the most frequent 331 (41.1%), followed by condyle (135) and angle (124) fractures in occurrence. Mandibular angle fractures were found mostly to be associated with assault victims.

CONCLUSION

The mechanism of injury correlates significantly with the anatomic location of fracture and knowledge of these associations should guide the surgeons for appropriate and timely management. Because RTAs are most frequent, good traffic sense needs to be imbibed and developed by the government as well as the public.

Prevalence of mandibular fractures reported at C.S.M.S.S Dental College, aurangabad from february 2008 to september 2009

Aim:

The aim of this study is to determine the etiology, frequency of mandibular fractures among different age and sex, to determine the frequency of anatomic distribution, and to report the different modalities of treatment provided to the patients reported at our institution from February 2008 to September 2009.

Materials and Methods:

All patients fulfilling the selection criteria and having mandible fracture were selected for the study. Patient information was collected by means of a medical data form specifically designed for the present study. The values were subjected to Z and Chi-square tests.

Results:

Out of 35 patients, thirty one were males (88.57%) and four were females (11.43%) with a male:female ratio of 8:1. We found a peak occurrence in young adults, aged 21-30 years (n = 15, 42.86%). In case of etiology of fracture, road traffic accidents (RTAs) was the most common (n = 25, 71.43%) and condyle was most frequently involved site (n = 19, 38.78%). In most (n = 16, 45.71%) of the patients, an open reduction and rigid internal fixation using bone plate and screws was done.

Conclusion:

In the present study, the prevalence of mandible fractures was more prevalent in male patients, especially during the 3^rd decade of life. The most common cause was road traffic accident and the more frequently affected region was condyle of the mandible. Open reduction and rigid internal fixation using miniplates and screws was the most commonly used treatment.

Mandibular fractures at veer chandra singh garhwali government medical science and research institute, garhwal region, uttarakhand, India: a retrospective study

Background:

Mandibular fractures constitute a substantial proportion of cases of maxillofacial trauma. Demographic data related to mandibular fractures are difficult to evaluate because of many variables associated with the studies. The information is as diverse as the countries and the people who inhabit them.

Aim:

This is a retrospective study designed to determine the site distribution, associated fracture and causes of mandibular fractures in patients presenting to the trauma centre of Veer Chandra Singh Garhwali Government Medical Science and Research Institute, Uttarakhand, India.

Materials and Methods:

Records of 121 patients with confirmed mandibular fractures presenting over a three year period (i.e., 1^st January 2008 to 31^st December 2010). Data obtained from record included age, sex, site of fracture and causes.

Results:

There were 48/121 (39.6%) males and 73/121 (60.3%) females. The most predominant age group of fracture was found to be 21-30 (53/121-43.8%) followed by 11-20 (25/121-20.6%). In this study history of fall was the most common cause of mandibular fracture (66/121-54.5%), followed by road traffic accidents (45/121-37.1%), fights and assault (08/121-6.6%) and industrial accidents (02/121-1.6%). In our study most of the patients suffered from fracture in the parasymphysis (35/139-25.1%) and angle region (32/139-23.0%) followed by body (30/139-21.5%), condyle (21/139-15.1%), symphysis (19/139-13.7%), and ramus (02/121-1.4%) area.

Conclusion:

In this study mandibular fractures were more prevalent in females especially during the second and third decade of life. History of fall was the most predominant cause of mandibular fracture. The most frequently affected sites were parasymphysis and angle.

Analysis of 627 hospitalized maxillofacial-oral injuries in Xi'an, China

BACKGROUND

Maxillofacial-oral injuries is a serious health problem in China. The main aetiologic factors and types of maxillofacial-oral injuries differ according to different geographical areas and socio-economic statuses of populations in different countries or within the same country.

AIM

The aim of this study was to analyze the types and external causes of maxillofacial-oral injuries among hospitalized patients in Xi'an, China, and thereafter to determine the status of maxillofacial-oral injuries in this region and to provide clinical clues for a future prevention of these injuries.

MATERIAL AND METHODS

Totally, 627 patients aged 3-64 years with maxillofacial-oral injuries, who were hospitalized in two public stomatological hospitals in Xi'an from 1 January 2008 to 31 December 2008, were included in this study. The types and external causes of injuries were analyzed in terms of age, gender and urban and rural location.

RESULTS

The results showed that jaw fractures (n = 406, 64.8%) and contusion/laceration injuries (n = 161, 25.7%) were the most frequent injuries. Injuries were 4.6 times more common in males than in females. Most maxillofacial-oral injuries occurred in those aged 18-59 years (71.1%), with a peak incidence in the 15- to 39-year-old group (31.4%). The proportion of patients from urban areas (45.5%) was lower than that from rural areas (54.4%). Regardless of gender, age and location, vehicle traffic accidents was the most common cause (n = 263, 41.9%), followed by falls (n = 109, 17.2%) and fighting-induced injuries (n = 87, 13.9%).

CONCLUSIONS

Preventive strategies for maxillofacial-oral injuries due to traffic accidents should be emphasized and promoted in the first hand, especially for males, rural residents and those aged between 18 and 59 years.

Epidemiology and clinical characteristics of traumatic brain injuries in a rural setting in Maharashtra, India. 2007-2009

Context:

Though some studies have described traumatic brain injuries in tertiary care, urban hospitals in India, very limited information is available from rural settings.

Aims:

To evaluate and describe the epidemiological and clinical characteristics of patients with traumatic brain injury and their clinical outcomes following admission to a rural, tertiary care teaching hospital in India.

Settings and Design:

Retrospective, cross-sectional, hospital-based study from January 2007 to December 2009.

Materials and Methods:

Epidemiological and clinical data from all patients with traumatic brain injury (TBI) admitted to the neurosurgery service of a rural hospital in district Wardha, Maharashtra, India, from 2007 to 2009 were analyzed. The medical records of all eligible patients were reviewed and data collected on age, sex, place of residence, Glasgow Coma Scale (GCS) score, mechanism of injury, severity of injury, concurrent injuries, length of hospital stay, computed tomography (CT) scan results, type of management, indication and type of surgical intervention, and outcome.

Statistical Analysis:

Data analysis was performed using STATA version 11.0.

Results:

The medical records of 1,926 eligible patients with TBI were analyzed. The median age of the study population was 31 years (range <1 year to 98 years). The majority of TBI cases occurred in persons aged 21 - 30 years (535 or 27.7%), and in males (1,363 or 70.76%). Most patients resided in nearby rural areas and the most frequent external cause of injury was motor vehicle crash (56.3%). The overall TBI-related mortality during the study period was 6.4%. From 2007 to 2009, TBI-related mortality significantly decreased (P < 0.01) during each year (2007: 8.9%, 2008: 8.5%, and 2009: 4.9%). This decrease in mortality could be due to access and availability of better health care facilities.

Conclusions:

Road traffic crashes are the leading cause of TBI in rural Maharashtra ffecting mainly young adult males. At least 10% of survivors had moderate or more severe TBI-related disabilities. Future research should include prospective, population based studies to better elucidate the incidence, prevalence, and economic impact of TBI in rural India.

Occurrence of traumatic dental injury in cases of domestic violence

The purpose of this study was to investigate the prevalence and types of traumatic dental injuries in situations of domestic violence. A coross-sectional study was conducted and data were collected from the police occurrence records to domestic physical aggression between 2001 and 2005. Of the 1,844 subjects who underwent medical evaluation, 15 had information pertaining to traumatic dental injuries. From the medical records, the forensic medical reports completed by the forensic medical experts who examined the victims after the aggression were reviewed and data of individuals with dental injuries (e.g., fractures, luxation and avulsion) were collected. In the selected sample, there was a predominance of individuals with injuries to the head and neck region (38.7%), and the frequency of traumatic dental injuries among all injuries to the head and neck region was 2.0%. The most frequently injured teeth were the maxillary incisors (31.8%), followed by the mandibular incisors (27.3%) and the maxillary canines (9.1%). In 31.8% of the injured teeth, the forensic experts did not specify the nomenclature. Of the dental trauma cases, 59.1% were fractures, 27.2% were luxations and 13.7% were avulsions. In conclusion, domestic violence was an important etiologic factor of traumatic dental injury. The aggression in all cases occurred in the form of punches and slaps. Fracture was the most common type of traumatic dental injury, and the most frequently injured teeth were the incisors.

Pattern of maxillofacial fractures at a tertiary hospital in northern India: a 4-year retrospective study of 718 patients

PURPOSE

Pattern and aetiology of maxillofacial injuries varies from one country to another and even within the same country depending on prevailing socio-economic, cultural and environmental factors. Various studies have been carried out in various countries to study the epidemiology and demographics of the maxillofacial injuries but the studies from India are few.

MATERIAL AND METHODS

Retrospective study was undertaken at Christian Medical College Ludhiana (India) from January 2006 to December 2009. Treatment records of the patients was checked and age, gender, aetiology of injury, associated injuries, maxillofacial fractures and treatment offered were recorded.

RESULTS

A total of 1075 fractures were recorded in 718 patients, ranging from 11 months to 85 years of age. Male:female ratio was 6.6:1. Maxillofacial injuries were most common in third decade of life. A total of 517 patients suffered injuries because of road traffic accident, 115 because of accidental fall and 67 because of interpersonal violence. A total of 184 patients had 221 associated injuries of which 56.1% head injuries, 29.0% orthopaedic injuries and 14.9% other injuries were present. Of 596 middle third fractures, 29.8% were managed conservatively; for 21.7% and 48.7% of fractures, closed reduction and open reduction were performed respectively. Of 479 mandibular fractures, 1.8% was managed conservatively; for 16.7% and 81.5% fractures, closed reduction and open reduction were performed respectively.

CONCLUSION

Better socio-economic status of people, increased vehicular movements and non-implementation of road safety norms have increased road traffic accidents. Proper education of the people who are most commonly involved in the RTA can be one of the possible ways to reduce the maxillofacial injuries.

Biomechanical properties of the body and angle of the sheep mandible under bending loads

AIM

The aim of the study was to compare the body and angle of the sheep mandible in terms of bone density and biomechanical competence under bending load conditions.

MATERIAL AND METHODS

Nineteen sheep mandibles were used in this study. The mandibles were separated at the symphysis into two halves. Three regions of interest on the body and angle of the hemi-mandibles were selected for measurements of bone mineral density (g cm(-2) ) by dual energy X-ray absorbtiometry. Biomechanical properties of the left mandibular body and right mandibular angle were measured by three-point bending test using a material testing machine. The load and deformation were recorded, and the load-deformation curves were obtained. The values of failure load (FL), yield load (YL), yield deformation (YD), postyield deformation (PD), stiffness, energy to yield point (EY) and energy to failure point (EF) were calculated with the analysis of load-deformation curves. Groups were compared using independent samples Student's t-test.

RESULTS

The mandibular angle exhibited the lower bone density (-64%) and biomechanical properties (FL; -45%, YL; -40%, PD; -7% stiffness, -40% EY; -48% and EF; -34%) than the mandibular body under bending loads, and there was no significant difference in values of YD between the two regions.

CONCLUSION

Our results show that the mandibular angle is weaker than the mandibular body under bending loads.